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Herein, we propose a minimally invasive approach using High-Intensity Focused Ultrasound (HIFU) for microscale removal of carious dentine. Concurrently, HIFU\u2019s antimicrobial effects against associated cariogenic biofilms and the corresponding thermal and biological impacts on surrounding tissues were investigated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 238 sound human molars were utilized, with 203 samples of artificial carious-simulated dentine (ACSD) prepared for HIFU exposure. HIFU (250\u00a0kHz) was applied at 20\u00a0W for varying durations (60, 120, and 180\u00a0s). The acoustic waves were administered via a collimated cone coupled to the dentine surface using ultrasonic gel.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Advanced characterization techniques including scanning electron microscopy (<jats:italic>n<\/jats:italic>\u2009=\u20095\/group), Raman spectroscopy, atomic force microscopy, and nano-indentation (<jats:italic>n<\/jats:italic>\u2009=\u20095\/group), demonstrated HIFU\u2019s effectiveness in removing demineralized collagen-fibrils. This was reflected in the increased mineral content, nano-hardness, and reduced elastic-modulus of ACSD lesions. Micro-CT (<jats:italic>n<\/jats:italic>\u2009=\u20096\/group) confirmed the increase in mineral density post-HIFU exposure. Confocal microscopy of Rhodamine-B stained ACSD (<jats:italic>n<\/jats:italic>\u2009=\u20095\/group) quantified the depth of dentine microscale removal post-HIFU exposure in a time-dependent manner. HIFU\u2019s potent anti-biofilm effect (<jats:italic>n<\/jats:italic>\u2009=\u20099\/group) against <jats:italic>Streptococcus mutans<\/jats:italic> biofilms was evidenced by microscopic characterizations and significant reductions in metabolic-activity and colony-forming units. Furthermore, HIFU promoted the proliferation of dental pulp stem cells (<jats:italic>n<\/jats:italic>\u2009=\u20093\/group) while maintaining the associated temperature-rise within the physiological tolerance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>HIFU\u2019s potential as an innovative, minimally invasive, non-ionizing tool for dentine carious lesion micromanipulation was demonstrated through the interaction between focused acoustic waves and dentine, warranting further studies for future clinical translation in restorative and\/or preventive dentistry.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12967-024-06008-7","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T10:52:21Z","timestamp":1736333541000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["High-intensity focused ultrasound: an innovative approach for micro-manipulation of demineralized dentine"],"prefix":"10.1186","volume":"23","author":[{"given":"Sheetal Maria","family":"Rajan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barsha","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6357-0535","authenticated-orcid":false,"given":"Amr","family":"Fawzy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"issue":"7","key":"6008_CR1","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1111\/iej.13128","volume":"52","author":"L Bjorndal","year":"2019","unstructured":"Bjorndal L, Simon S, Tomson PL, Duncan HF. 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